Skip to main content
SpringerLink
Log in

Reliability of various diastasis measurement methods on weightbearing radiographs in patients with subtle Lisfranc injuries

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

This study aimed to evaluate the reliability of the diastasis measurements between the medial cuneiform and the second metatarsal on weightbearing radiography.

Materials and methods

We retrospectively examined 18 patients who underwent open surgery for subtle Lisfranc injuries. Preoperative weightbearing radiography of the affected and unaffected feet was evaluated in all patients. The diastasis between the medial cuneiform and the second metatarsal was measured in both feet using the following four methods: diastasis between parallel lines, distal point diastasis, middle point diastasis, and proximal point diastasis. Intraclass correlation coefficients with consistency of agreement were calculated to evaluate inter- and intraobserver reliability.

Results

The intra- and interobserver reliabilities of all four methods were good. Intraclass correlation coefficients for intraobserver reliability ranged from 0.87 to 0.93. Those for interobserver reliability ranged from 0.81 to 0.91.

Conclusions

The reliabilities of the diastasis measurement methods between the medial cuneiform and the second metatarsal on weightbearing radiography were good. Measuring the diastasis between the medial cuneiform and the second metatarsal on weightbearing radiography is useful in evaluating subtle injuries when uniform measurement methods are used.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ponkilainen VT, Laine HJ, Mäenpää HM, Mattila VM, Haapasalo HH. Incidence and characteristics of midfoot injuries. Foot Ankle Int. 2019;40(1):105–12.

    Article  Google Scholar 

  2. Watson TS, Shurnas PS, Denker J. Treatment of Lisfranc joint injury: current concepts. J Am Acad Orthop Surg. 2010;18(12):718–28.

    Article  Google Scholar 

  3. Nunley JA, Vertullo CJ. Classification, investigation, and management of midfoot sprains: Lisfranc injuries in the athlete. Am J Sports Med. 2002;30(6):871–8.

    Article  Google Scholar 

  4. Renninger CH, Cochran G, Tompane T, Bellamy J, Kuhn K. Injury characteristics of low-energy Lisfranc injuries compared with high-energy injuries. Foot Ankle Int. 2017;38(9):964–9.

    Article  Google Scholar 

  5. Myerson MS, Cerrato RA. Current management of tarsometatarsal injuries in the athlete. J Bone Joint Surg Am. 2008;90(11):2522–33.

    PubMed  Google Scholar 

  6. Kösters C, Bockholt S, Müller C, Winter C, Rosenbaum D, Raschke MJ, et al. Comparing the outcomes between Chopart, Lisfranc and multiple metatarsal shaft fractures. Arch Orthop Trauma Surg. 2014;134(10):1397–404.

    Article  Google Scholar 

  7. Sherief TI, Mucci B, Greiss M. Lisfranc injury: how frequently does it get missed? And how can we improve? Injury. 2007;38(7):856–60.

    Article  Google Scholar 

  8. Sripanich Y, Weinberg MW, Krähenbühl N, Rungprai C, Saltzman CL, Barg A. Reliability of measurements assessing the Lisfranc joint using weightbearing computed tomography imaging. Arch Orthop Trauma Surg. 2021;141(5):775–81.

  9. Rankine JJ, Nicholas CM, Wells G, Barron DA. The diagnostic accuracy of radiographs in Lisfranc injury and the potential value of a craniocaudal projection. AJR Am J Roentgenol. 2012;198(4):W365–369.

  10. Siddiqui NA, Galizia MS, Almusa E, Omar IM. Evaluation of the tarsometatarsal joint using conventional radiography, CT, and MR imaging. Radiographics. 2014;34(2):514–31.

    Article  Google Scholar 

  11. Sripanich Y, Weinberg MW, Krähenbühl N, Rungprai C, Mills MK, Saltzman CL, et al. Imaging in Lisfranc injury: a systematic literature review. Skeletal Radiol. 2020;49(1):31–53.

    Article  Google Scholar 

  12. Ponkilainen VT, Partio N, Salonen EE, Riuttanen A, Luoma EL, Kask G, et al. Inter- and intraobserver reliability of non-weight-bearing foot radiographs compared with CT in Lisfranc injuries. Arch Orthop Trauma Surg. 2020;140(10):1423–9.

  13. Sands AK, Grose A. Lisfranc injuries. Injury. 2004;35(Suppl 2):SB71-76.

    Article  Google Scholar 

  14. Wynter S, Grigg C. Lisfranc injuries. Aust Fam Physician. 2017;46(3):116–9.

    PubMed  Google Scholar 

  15. Seo DK, Lee HS, Lee KW, Lee SK, Kim SB. Nonweightbearing radiographs in patients with a subtle lisfranc injury. Foot Ankle Int. 2017;38(10):1120–5.

    Article  Google Scholar 

  16. Aronow MS. Treatment of the missed Lisfranc injury. Foot Ankle Clin. 2006;11(1):127–42, ix.

    Article  Google Scholar 

  17. Faciszewski T, Burks RT, Manaster BJ. Subtle injuries of the Lisfranc joint. J Bone Joint Surg Am. 1990;72(10):1519–22.

    Article  CAS  Google Scholar 

  18. Haraguchi N, Ota K, Ozeki T, Nishizaka S. Anatomical pathology of subtle Lisfranc injury. Sci Rep. 2019;9(1):14831.

    Article  Google Scholar 

  19. Thomas JL, Kopiec A, Mark K, Chandler LM. Radiographic value of the Lisfranc diastasis in a standardized population. Foot Ankle Spec. 2020;13(6):494–501.

  20. Abdelaziz ME, Hagemeijer N, Guss D, El-Hawary A, El-Mowafi H, DiGiovanni CW. Evaluation of syndesmosis reduction on CT scan. Foot Ankle Int. 2019;40(9):1087–93.

    Article  Google Scholar 

  21. Potter HG, Deland JT, Gusmer PB, Carson E, Warren RF. Magnetic resonance imaging of the Lisfranc ligament of the foot. Foot Ankle Int. 1998;19(7):438–46.

    Article  CAS  Google Scholar 

  22. Benirschke SK, Meinberg E, Anderson SA, Jones CB, Cole PA. Fractures and dislocations of the midfoot: Lisfranc and Chopart injuries. J Bone Joint Surg Am. 2012;94(14):1325–37.

    Article  Google Scholar 

  23. Panchbhavi VK, Andersen CR, Vallurupalli S, Yang J. A minimally disruptive model and three-dimensional evaluation of Lisfranc joint diastasis. J Bone Joint Surg Am. 2008;90(12):2707–13.

    Article  Google Scholar 

  24. Knijnenberg LM, Dingemans SA, Terra MP, Struijs PAA, Schep NWL, Schepers T. Radiographic anatomy of the pediatric Lisfranc joint. J Pediatr Orthop. 2018;38(10):510–3.

    Article  Google Scholar 

  25. Eliasziw M, Young SL, Woodbury MG, Fryday-Field K. Statistical methodology for the concurrent assessment of interrater and intrarater reliability: using goniometric measurements as an example. Phys Ther. 1994;74(8):777–88.

    Article  CAS  Google Scholar 

  26. Hartmann DP. Considerations in the choice of interobserver reliability estimates. J Appl Behav Anal. 1977;10(1):103–16.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan

    Yuki Sugino, Ichiro Yoshimura, Tomonobu Hagio, Tetsuro Ishimatsu, Masaya Nagatomo & Takuaki Yamamoto

Authors
  1. Yuki Sugino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ichiro Yoshimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomonobu Hagio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tetsuro Ishimatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masaya Nagatomo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takuaki Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ichiro Yoshimura.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sugino, Y., Yoshimura, I., Hagio, T. et al. Reliability of various diastasis measurement methods on weightbearing radiographs in patients with subtle Lisfranc injuries. Skeletal Radiol 51, 801–806 (2022). https://doi.org/10.1007/s00256-021-03892-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-021-03892-8

Keywords

Search

Navigation